To my fellow students of Chinese medicine who love the medicine itself, but struggle with standardized testing, this is for you.
A note for non-practitioners about acupuncture licensing exams
In the USA, Chinese medicine is state- regulated. California has the most stringent educational and other licensing requirements. It is the only state that does NOT recognize the National acupuncture licensing exam (NCCAOM). The NCCAOM has four modules: foundations, acupuncture, Western medicine, and herbal medicine. Each module is taken separately, with 100 questions and 2.5-hours each. This makes it easier for students to prepare for the exam, studying one topic at a time.
The California Acupuncture Licensing Exam (CALE) combines the four NCCAOM modules into a grueling 5-hour 200-question exam with more trick questions, complex case studies, and clinically irrelevant trivia than the NCCAOM.
Test Preparation programs
Here are the three main test preparation programs, listed from least to most expensive:
- TCMreview.com (I used this program)
- TCMtests.com (I used only during free days)
Using a test preparation program streamlines the intimidating process of reviewing 4 years of accumulated material, 2000 years of history, changing rules/ regulations, and shifting western medicine research.
Choose either TCM-review or Linda Morse’s program for your base program. Search on Youtube for some free sample videos from both to taste their teaching style, and see what resonates. I enjoyed TCM-review’s well-organized content. Bina teaches all of the Chinese medicine classes, methodically covering what to focus on through HB Kim and the course reader. Whenever I had a question, I directly emailed or called her, which was deeply helpful. TCM-review posts free review questions onto Facebook daily.
TCM-tests has helpful test review questions. The first Tuesday of every month is free. So, go test-drive the site to check it out! They post daily review questions onto their site, as well.
I enrolled in TCM-review’s self-guided CALE preparation program during my final quarter of school. I struggled to finish the weekly modules, which included 3 hours of videos, a handful of quizzes, and readings. I went overboard and exhausted myself for the first few months, before I learned to keep it simple:
- Only highlight, write down, or study what Bina emphasizes.
- If something is particularly confusing, either look up more information in a different academic resource or email Bina. She usually responds within a day, with helpful and encouraging explanations/ suggestions.
Time management
My first panic attack hits at 4:30 AM, a month before my first exam, the NCCAOM foundations module. As I stand retching over the bathroom sink in the pre-dawn darkness, I realize I have to change. I was working too hard, and driving myself into an inefficient, anxious frenzy.
I re-prioritized my study strategies and life design:
Mornings
- I journal and sip tea first thing in the morning (usually around 5 AM), prior to studying, or any internet exposure. I light a candle and some incense, invoking support from my ancestors (excellent test takers), and the Earth.
- I then study until 6 or 7 AM, going through whatever is most important, usually taking a quiz, watching a video, or editing flashcards.
- After morning study, I practice yoga asana, eat breakfast, then resume studies by 9 AM.
I enjoy a weekly “study adventure” to local wild places, overflowing my fanny pack with food and study material. I walk, bike, and drive to a rotating collection of mountains, rivers, local parks, and the ocean.
Work
After graduating, I increased my yoga-teaching class load to 7 studios, scheduling classes in the evenings, when I am less productive, but ready for social engagement. Test preparation can be lonely, and mentally, emotionally, and spiritually draining. Teaching yoga provided an incredible balance: I share what I love, engage with people who I care about, and integrate information on all levels.
Are you more focused and productive in the mornings or evenings? Pattern your day according to your natural rhythms. I honor my "morning person" temperament by only scheduling appointments after lunch.
I cancelled all teaching engagements three weeks before my exam. Walking in the hills going through flashcards, I notice rising anxiety and overwhelm, and realize, “I do NOT want to teach tonight’s class.” I was so focused that any disturbances would cause more stress.
Notice how you are feeling. Make life changes as necessary to support your study success!
Evenings
I prefer studying outdoors during the day, and doing computer-oriented work in the evening, such as taking quizzes, editing flashcards, or watching videos. I try to climb into bed by 10 PM. Most nights, I feel a sense of guilty incompleteness: I didn’t study enough today. I felt a constant sense of not enough. This feeling is miserable and useless, but difficult to combat. I tried to push it back by covering flashcards until I fell asleep, but this would usually give me anxiety-dreams, or nightmares.
Set a time to stop studying. Give yourself a break. It’s difficult to stop, when you’re a perfectionist workaholic (as I am). But, it’s absolutely necessary, to prevent burnout, panic attacks, or worse. Resting peacefully each evening allows information integration, building long-lasting brain-trails.
Flashcards
Bina recommends making flashcards for everything covered in the course (besides what you know very well already) and having a daily strategy of studying all flashcards nightly, setting aside cards you’re getting wrong, then reviewing the “wrong” flashcards first thing the next morning.
I couldn't use Bina's technique. I made a total of 8350 flashcards through my six months of study, assiduously inputting each week’s information into Quizlet. I was overwhelmed by my massive collection, and inefficient in reviewing them. I quickly fall asleep if I sit around and study. I need constant movement and diverse natural environments.
The still sacred silence of the hills/ mountains helps me focus; I quickly move through large amounts of study material. I walk with flashcards until I find a beautiful place to study, am hungry, or am so mentally exhausted that I must rest. I then sit in the shade, flip through books or charts, or cover larger flashcards that are too complicated to read while walking.
Paper flashcards get bulky and fly away when it’s windy. I prefer online/ digital flashcards. Quizlet supported me through graduate school, and continued to help me pass my board exams. I enjoy adding photos onto complex cards, keeping cards organized in folders, seeing other students' cards, and Quizlet's ability to read me my cards. I walk, listening to my cards, starring and unstarring, gazing down every once in a while for clarification.
I organize material into specific folders, numbered according to priority. I “star” my "wrong" flashcards, studying the starred cards the next day. I keep track of everything by charting when I cover a flashcard set, how many are starred, and how many total in the set. As my test date drew closer, I noted "mastered" categories with a blue circle.
I created larger flashcard categories for sitting and reading/ studying. I created smaller flashcards for walking. I noted which flashcards were for walking (走), or sitting (坐).
Keep topics small, to move through quickly, and Quizlet-readable while walking. Color-code. Write things down over and over. Make studying fun, colorful, and physical.
It’s a Marathon
I prepared for the CALE for 6 months. During school, I studied as much as possible between school, work, and 450 miles of travel each week. After graduation, I studied every single day, all day on most days. I scheduled in at least one hour-long physical activity daily, besides teaching and practicing yoga. Your study strategy depends on you.
What type of learner are you? I’m a kinesthetic learner and artist. I enjoy the physicality of programming flashcards into the computer, making them fun and beautiful, and then walking with them through miles of wilderness. Bina suggested a rigorous study schedule: scheduling topics each morning, then studying in 2 hour blocks. I tried to follow the regimen off and on for a few months, and found it anxiety-provoking. I am much happier and more efficient if I get up when I need to, otherwise I procrastinate. When I get slightly restless, I set the timer for 5-10 minutes, then take a snack, garden, or creativity break until time's up. When very restless, I shut everything down, and go for a flashcard walk up the hill or down to the ocean. You are in control of your study-journey.
When you’re bored, exhausted, or procrastinating, go take a break. Stay efficient. Don’t get bogged down in details. Clarify what you don’t understand, then move on.
Rest
Schedule in time for rest and play. Spend time outdoors. Get exercise. Spend time with friends.
These things are simple to say, but must be scheduled in during test preparation. Otherwise, focused zeal can take over, frazzling the nervous system.
Have fun with your studies. How can this process be joyful? This is a precious moment. You are here now, and will not be here again, as a soon-graduating or freshly-graduated acupuncturist, preparing for licensure. This is purgatory. Welcome here now. Look around. Enjoy it, while you’re here. Have fun.
Test Preparation Tips
I focused on my weak spots during TCM-tests free days, the first Tuesday of each month. I took all most of their mock exams for each NCCAOM category prior to those exams, also during free days. I scheduled weekly mock exams the final month leading to the CALE (part of the TCM-review program). Utilize both free and paid resources!
I memorized the entire “Big Picture” page from HB Kim, and all 83 formulas and categories. I scribbled both down within 20 minutes every week. If I started dropping information or going slower, then I would increase the frequency to twice a week, every other day, or daily.
Prior to my actual exam, I scribbled down most of the Big Picture, then added other acupuncture or herbal lists as necessary. They only allowed me one piece of scratch paper, so I kept my reference tables concise. I repeatedly wrote and erased notes throughout the test in the remaining space.
I developed these test-taking strategies during my 4 mock exams. I tested in a quiet focused environment, similar to the actual testing environment. I gave myself a 10-minute bathroom/ snack break every 50 questions, which I aimed to finish in an hour. I’d studied enough that I trusted my intuition more than my logical mind: if my first thought is A, then go with it. Don’t doubt, and certainly don’t overthink. Keep it simple. Keep moving.
Western medicine
I felt prepared to take my exam with my review course, except for western medicine. Western medicine is a vast topic. The professor who covered that section of the TCM-review course frequently went off-topic, veering into personal/ clinical stories that are interesting, but unnecessary for test preparation. I sped through those videos at 2.5x speed.
I spent three days sitting by the ocean, reading through the entire biomedicine section of HB Kim. I made tables for what I found confusing or intriguing, and drilled flashcards and quizzes.
Scheduling exams
Most California students take both the NCCAOM and CALE, for a total of five exams. After doing much research, I too chose this route, although it is more expensive, stressful, and time-consuming. It is better to take these exams while the information is still fresh from school. Once clinical practice begins, the didactic academic information falls away, while sitting-still-and-studying ability also declines.
Either complete or start taking the NCCAOM while still in school. Most of my peers from my past schools (in FL and OR) completed the NCCAOM while finishing their final year of school. I incorrectly thought that that rule was different in California, but it is not: pass it while it’s hot. Get it done.
My testing schedule
Bina was instrumental in my study strategy. I came to deeply trust her judgment. She suggested taking the NCCAOM foundations and acupuncture modules first, CALE, and then biomedicine and herbs. Because of time constraints, my testing schedule ended up as:
1. NCCAOM foundations module
2. CALE
3. NCCAOM acupuncture module
4. NCCAOM biomedicine module
5. NCCAOM herbs module
After graduation, I focused my energy and passed the NCCAOM foundations module. You can read about that journey here. Preparing for the foundations module solidified that information in me. I felt confident and indestructable here, only revisiting these flashcards intermittently until my big CALE exam, rifling through one final time right before CALE.
I took the NCCAOM acupuncture module one week after the CALE. It has slightly different content than the CALE, which required an about-face in these categories:
- needle depth
- point location
- crossing points
I read through HB Kim for these sections, and scoured Quizlet for others’ resources. I only drilled these categories, trusting that my CALE-prep was sufficient to also carry me through the NCCAOM for other categories, especially within such a short span of time between these two exams.
Success.
The test
Visit my "Ode to Tests" post for some before, during, and after test strategies and suggestions.
The end
“Geoff,” I texted my mentor, two weeks before my scheduled CALE exam, “Can we talk?” We spoke on the phone a few hours later. I had completed my 6-month TCM-review course. My CALE exam was scheduled in 2 weeks. I still didn’t feel ready. I was confident in some areas, but weak in other areas. I knew my weak spots, and feared them. Am I good enough? Am I ready enough? Take it now, or push the test back? Geoff counseled me, “Give it all you’ve got. You’ve studied. You’re prepared. You’re at peak performance state. Get it.” He said, “Go in with the intention to kill the beast. Even if you don’t kill it, you hurt it bad. It walks away limping.” This fiery bold image, coupled with my usual more-peaceful ancestral-prayers, and months of dedication and struggle, carried me through to test day.
“祖先們! (Zu xian men),” I call out to the sunrise ocean, “Ancestors!” I’ve already walked through a few hundred flashcards in the dawn chill, barefoot through the cold sand. I feel tired and overwhelmed, and am asking for support from my ancestors, the same questions I would later ask Geoff: Am I ready? Is it time?
Six dolphins simultaneously swim by, blow-holing parallel sprays of water high above waves, alighting my heart with hope and possibility. Here we are.
The beginning (What now?)
I’m building my practice. It’s difficult to rest after months of intense dedication. The fire that lit my test-preparation path now guides my business-building trail. This is a life-long journey of adventurous study, with its challenges and triumphs. I am grateful.
Have fun!
